DisciplinaFarmacognosia I619 materiais • 4.486 seguidores
which contains more than 200 patients and done cooperatively at different institutions to evaluate the ef\ufb01cacy of escin to improve sperm quality in male patients with varicocele-associated infertility. Among the four possible mechanisms by which varicocele results in male infertility stated in the Introduction part, venous stasis and testicular oxidative stress have been paid much attention in recent clinical studies (Cavallini et al. 2003; Oliva et al. 2008; Turner and Lysiak 2008). Escin has the function of anti- oxidative stress which directly targets at one of the proposed mechanisms mentioned above (Jarow 2001; Kamischke and Nieschlag 2001; Marmar 2001; Naughton et al. 2001; Sirtori 2001; Carrasco and Vidrio 2007; Oliva et al. 2008). In fact, the primary pathological changes of spermatic varicocele include venous tortuosity, thinner venous wall, dysplasia of venous wall muscles, \ufb01brosis of vessel wall and atrophy of outer membrane and middle layer. These chronic in\ufb02ammation and changes in hemodynamic \ufb01nally cause this disorder (Jarow 2001; Kamischke and Nieschlag 2001; Marmar 2001; Naughton et al. 2001). Escin can inhibit lysosome in serum and reduces the permeability of capillary vessel (Sirtori 2001; Carrasco and Vidrio 2007). It can also protect collagen \ufb01ber of venous wall and increase wall tension and strength, which will help the recovery of tension and contraction function damaged by lesions on venous wall. Furthermore, it can increase venous drainage which will reduce venous congestion (Sirtori 2001; Carrasco and Vidrio 2007). Thus, escin presents two pharmacodynamic actions: anti-edematous properties and venotonic properties. In fact, it also has anti- in\ufb02ammatory activities (Carrasco and Vidrio 2007; Sirtori 2001). In this study, escin helped reduce the diameter of 47.0% of the spermatic veins (Table 3), which might be one of the anatomical and physiological bases for escin to improve sperm quality. Therefore, escin targets not only in the testis oxidative stress, but also in the venous stasis and chronic in\ufb02ammation of the vein, which are the three important proposed pathogenic mechanisms ery group (n ¼ 48) Escin group (n ¼ 106) Percentage (%) No. Percentage (%) 33.3 34 32.1 35.4 27 25.5 68.8\ufffd 61 57.5\ufffd 31.3 45 42.5 ARTICLE IN PRESS Surg No. 21 16 37 11 esc nta \ufffd,\ufffd\ufffd Y. Fang et al. / Phytomedicine 17 (2010) 192\u2013196 195 Table 2 The improvement of sperm motility (Grade a+Grade b) after escin treatment. Control group (n ¼ 65) No. Percentage (%) Highly effective 10 15.4 Effective 20 30.8 Overall effective 30 46.2 Not effective 35 53.8 Note: Compared to the control group. \ufffd Po0.05. Table 3 The improvement of the diameter of spermatic vein of 151 sides in 106 cases after Mild (n ¼ 96) Moderate (n ¼ 45) No. Percentage (%) No. Perce Highly effective 11 11.5 13 28.9 Effective 29 30.2 16 35.6 Overall effective 40 41.7 29 64.4 Not effective 56 58.3 16 35.6 causing varicocele-associated infertility. Thus, it is not surprising that escin can improve sperm quality in male patients with varicocele-associated infertility. It is worthwhile to point out that this study showed that the escin treatment was not effective for patients with severe varicocele (the diam of the spermatic vein44mm). This suggests that there is some degree of correlation between the severity of varicocele and the ef\ufb01cay of escin. One explanation might be due to the fact that the venous walls in patients with severe varicocele have been destroyed severely so that they lost their ability to recover their tension and function. In fact, this study demonstrates that escin is not only very effective to improve sperm quality but also it is well tolerated. Only very low frequencies of mild adverse effects were observed during treatment, most of which resolved without further symptomatic drug therapy after advising the patients to take escin after meal. Escin has little effect on vital signs, blood counts, liver or kidney function. Therefore, escin is a safe drug to improve sperm quality in male patients with varicocele-associated in- fertility. In this study, all groups including the control group are given composite medicines due to ethic consideration. Thus, it is dif\ufb01cult to pinpoint that the improvement in sperm quality is Note: Compared to the severe subgroup. \ufffd Po0.05. Compared to the mild subgroup. \ufffd\ufffd Po0.05. Table 4 Adverse effects observed during treatment. Control group (n ¼ 65) Sur No. Percentage (%) No. Fatigue 3 4.6 3 Stomach irritation 2 3.1 2 Anorexia 1 1.5 1 Nausea 3 4.6 1 Vomiting 0 0.0 1 Diarrhea 0 0.0 0 Constipation 0 0.0 0 Skin rash 0 0.0 0 Other 0 0.0 0 in treatment. Severe (n ¼ 10) Total (n ¼ 151) ge (%) No. Percentage (%) No. Percentage (%) 0 0.0 24 15.9 2 20.0 47 31.1 2 20.0 71 47.0 8 80.0 80 53.0 Percentage (%) No. Percentage (%) 43.8 30 28.3 33.3 29 27.4 77.1\ufffd 59 55.7 22.9 47 44.3 ery group (n ¼ 48) Escin group (n ¼ 106) due to escin alone or it is because escin has synergistic effect with the composite medicines. Obviously, in the future, it is necessary to design a study in animal models for spermatic varicocele which includes a pure placebo group and an escin group. In conclusion, escin is a safe and effective drug to improve semen quality in male patients with varicocele-associated in- fertility probably by reducing testis oxidative stress, decreasing in\ufb02ammatory responses, promoting the recovery of tension and contraction function damaged by lesions on venous walls. It provides new alternative treatment for male varicocele-associated infertility, especially for patients with mild or moderate varicocele. Con\ufb02ict of interest The authors have no con\ufb02ict of interest. Disclosure statement: The authors have nothing to disclose. Acknowledgments We thank Dr. Vincent DeMarco and Mr. Edward Downey from the University of Missouri for their helpful discussion. gery group (n ¼ 48) Escin group (n ¼ 106) Percentage (%) No. Percentage (%) 6.3 5 4.7 4.2 6 5.7 2.1 3 2.8 2.1 4 3.8 2.1 2 1.9 0.0 0 0.0 0.0 0 0.0 0.0 0 0.0 0.0 0 0.0 ARTICLE IN PRESS References Bielanski, T.E., Piotrowski, Z.H., 1999. 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